[Detection of Signs of Thrombus Formation in Patients With Typical Atrial flutter].

AIM: to assess rate of detection of markers of thrombi formation and to determine whether transthoracic echocardiography data or clinical characteristics predict severe left atrial appendage [LAA] dysfunction (low LAA velocity, severe spontaneous echo contrast [SEC], LAA thrombus) in patients with typical atrial flutter (AFI). MATERIAL AND METHODS: Consecutive 406 patients (299 with atrial fibrillation [AFib] and 107 with AFI) underwent transesophageal echocardiography before cardioversion. Mean age was 59.3 years, mean CHA2DS2-VASc score--1.86, mean LAA velocity--37.02 cm/s. RESULTS: Compared with patients with AF those with AFI had lower rate of detection of markers of thrombi formation (p < 0.05). Among patients with AFI 1.8% had SEC grade 4+, 7.4%--LAA velocity ≤ 25 cm/s. LAA thrombus was found in 2.8 and 8.1% of patients with AFI and AFib, respectively. Prevalence of thrombi in left ventricular (LV) cavity was significantly higher in patients with AFI (3.13 vs. 0.3% in patients with AFib, p = 0.02). In patients with AFI systolic LV dysfunction was the main and ost significant predictor of severe LAA dysfunction and presence LV thrombus. CONCLUSION: AFI associated high risk of embolic events is primarily determined by its adverse effect on LV function.

[Risk assessment for development of sudden cardiac death in patients with progressive angina (based on results of 4-year prospective study)]. / Metody otsenki riska razvitiia vnezapnoi kardial'noi smerti u bol'nykh, perenesshikh progrssiruiushchuiu stenokardiiu (po rezul'tatam 4-letnego prospektivnogo nabliudeniia).

In a 4-year follow-up of those patients having survived progressive angina (PA), the incidence rate was estimated of development of sudden cardiac death (SCD), with the aid of the Caplan-Mayer method and that of life tables. SCD rate has come to be 21.4% and 7.2% in the main group and that of patients free from structural affection of the myocardium. It is during the first year of the follow-up that patients with prior PA were at the greatest risk for SCD. It has been ascertained that aneurysm of the left ventricle and presence of chronic I-II degree cardiac insufficiency are independent and significant risk factors for SCD in those patients with history of PA.

[The dynamics of the functional indices of the cardiovascular system in patients with a history of progressing stenocardia]. / Dinamika funktsional'nykh pokazatelei serdechno-sosudistoi sistemy u bol'nykh, perenesshikh progressiruiushchuiu stenokardiiu.

The objective of this study was an assessment of time-related course of functional indices for the cardiovascular system in patients with prior advancing angina pectoris (AAP). A close inverse relation was found out between the time-related course of threshold load and work done in load testing and changes in the number of episodes of silent myocardial ischemia, overall duration of myocardial infarction during the 24-hour period, and depth of ischemic depression of ST segment in ECG. Higher/lower tolerance to physical loads in those patients in the post-AAP period is largely related to changes in indices for intracardiac hemodynamics, such as ejection fraction and left ventricular volume and degree of signs of ventricular electrical instability.

[The characteristics of the rehabilitative treatment of patients with a history of unstable stenocardia]. / Osobennosti vosstanovitel'nogo lecheniia bol'nykh, perenesshikh nestabil'nuiu stenokardiiu.

While examining forty-nine patients with the history of unstable angina pectoris (UAP), it was established that the sanatorium stage of rehabilitation with the proper extension of sick leave being accorded to such patients, is indicated in cases of low tolerability of physical exercise (50 wt and less) when discharged from hospital. Those patients with prior UAP who can tolerate physical exercise at 75 wt and above, are recommended to resume their work. In addition, improvement in tolerability of physical work loads in patients with prior UAP was found to be accompanied by diminution in the left ventricle cavity size.

[The structure of the ventricular arrhythmias in patients in the first 24 hours of a myocardial infarct]. / Struktura zheludochkovykh aritmii u bol'nykh v pervye sutki infakta miokarda.

Therapeutic interventions policy and efficiency rely on whether one succeeds in identifying accurately and in timely fashion the nature of ventricular arrhythmia which is frequently a primary manifestation of acute coronary disaster. With the view to studying cardiac arrhythmias in 85 patients with acute large size myocardial infarction admitted within 12 hours of the condition development. 24 h Holter monitoring was instituted. The results obtained showed only 27% of patients at relatively low risk development of life-threatening arrhythmias. In all the others, high grades ventricular extrasystoles are recorded, including episodes of ventricular tachycardia in 50% of the patients. High incidence rate of the complex rhythm disturbances development during first 12 hours of monitoring suggest a need for an adequate supplementary antiarrhythmic treatment to be administered within this time period, subsequent to which anti-ischemic therapy is thought to be capable of exerting sufficient antiarrhythmic effect.

[The intracardiac laser irradiation of the blood in correcting left ventricular dysfunction in progressive stenocardia]. / Vnutriserdechnoe lazernoe obluchenie krovi v korrektsii levozheludochkovoi disfunktsii pri progressiruiushchei stenokardii.

The authors studied the effect of intracardiac irradiation of blood with a low intensity Helium-Neon laser on the pumping function of left ventricle in 73 patients with progressive angina pectoris. 47 patients underwent a course of laser hemotherapy while being given medicamentous therapy, the remaining 26 received nitrates, calcium antagonists and analgesics. Employment of laser light irradiation was associated with more satisfactory clinical effect than that in patients who had not had the procedure. It has also been established that intracardiac laser light irradiation of blood makes for the improvement of the characteristics of the intracardiac haemodynamics by diminishing the volumes and augmenting the left ventricular (LV) ejection fraction. Beneficial effect of laser hemotherapy on the intracardiac haemodynamics characteristics results from the stabilizing influence the method exerts on LV regional contractility and appear to be associated with its anti-ischemic effect.

[The effect of quantum hemotherapy on the plasma hemostatic indices and fibrinolysis in patients with unstable angina]. / Vliianie kvantovoi gemoterapii na pokazateli plazmennogo gemostaza i fibrinoliz u bol'nykh nestabil'noi stenokardiei.

An evaluation was done in 172 patients with progressive stenocardia. The use of intracardiac laser light irradiation of blood in combined treatment was found to improve the clinical course of the illness and to have a beneficial effect on the factors of plasma haemostasis and fibrinolysis which play a pathogenetic role in the destabilization of the ischemic heart disease course, this being manifest by a significant decrease in the activity of factor XIII, platelet factor 4, and an increase in fibrinolysis.

[The prediction of the probability of the development of a myocardial infarct in patients with unstable angina]. / Prognozirovanie veroiatnosti razvitiia infarkta miokarda u bol'nykh s nestabil'noi stenokardiei.

Coronary reserve and functional state of myocardium were studied in 27 patients with unstable angina and myocardial infarction which had developed in spite of the treatment. Non-invasive study included stress-tests (transesophageal electrocardiostimulation, bicycle ergometry [correction of veloergometry)], echocardiography and Holter's monitoring. Possibility of early forming of risk group with consequent optimization of the treatment was shown.

[The initial experience of using fraxiparin in extracorporeal detoxication in clinical cardiology]. / Pervyi opyt primeneniia fraksiparina pri ékstrakorporal'noi detoksikatsii v klinicheskoi kardiologii.

Procedures, connected with extracorporal blood circulation--hemodialysis, hemosorption and plasmapheresis--were used in complex of treatment in 30 patients with various cardiovascular diseases. As an anticoagulant in 8 patients was used the preparation of low molecular heparine (Fraxiparine) produced by "Sanofi" (France) firm, and in 22-heparin, produced by "Polfa" (Poland). Ascertained advantages of Fraxiparine versus heparin were: possibility of single injection of preparation, the reducing of total dose magnitude, which is needed for one curative act conduction, lowering by 70% approximately the hemorrhagic complications rate.

[The complex assessment of myocardial electrical instability in exacerbated ischemic heart disease]. / Kompleksnaia otsenka élektricheskoi nestabil'nosti miokarda pri obostrenii ishemicheskoi bolezni serdtsa.

Risk of sudden coronary death in patients with unstable stenocardia is studied insufficiently. 39 patients with unstable stenocardia underwent Holter's monitoring, loading tests and invasive programmed ventricular stimulation coming lately into increasingly wide use for assessment of myocardial electric stability. Programmed stimulation allowed to single out two groups of patients: with ventricular tachycardia (56.4%) and without it (43.6%). Results obtained by aforementioned methods showed no correlation which is explained by the authors as being due to different pathogenetical mechanisms initiating ventricular arrhythmias. Thus, for example, rhythm disorders emerged not infrequently in the periods of ischemia during Holter's monitoring while myocardial ischemia was not observed in all cases of programmed ventricular stimulation. That is why complex approach needs to be pursued for assessment of electric stability of myocardium in patients with advancing stenocardia.

[The effect of ultraviolet-irradiated blood on the factors determining an unfavorable prognosis in patients with progressive stenocardia]. / Vliianie obluchennoi ul'trafioletovymi luchami krovi na faktory, opredeliaiushchie neblagopriiatnyi prognoz u bol'nykh s progressiruiushchei stenokardiei.

Effect of autohemotransfusions of ultraviolet-irradiated blood (UVIB) on ventricular arrhythmias and electric stability of myocardium were studied in 85 patients with advancing stenocardia. Bicycle ergometry [correction of Veloergometry], Holter's monitoring and invasive programmed cardiostimulation were used. Results of examination carried out before and after the treatment suggest anti-ischemic effect of PVIB and beneficial influence electrophysiological properties of myocardium which manifested in reduced periods of ventricular tachycardia and onsets of twin extrasystoles.

[The quantum hemotherapy of myocardial infarct patients]. / Kvantovaia gemoterapiia bol'nykh infarktom miokarda.

Results are reported of an examination of 81 patients with acute macrofocal myocardial infarction. Routine methods of treatment were supplemented by laser and ultraviolet radiation of the blood. This treatment was highly effective in rapid control of stenocardia pain, early stabilization of the ST segment. The proposed treatment is recommended in patients with acute myocardial infarction.

[Effects of laser irradiation of blood on electrical ventricular instability in patients with progressive angina pectoris]. / Vlianie lazernogo oblucheniia krovi na élektricheskuiu nestabil'nost' zheludochkov serdtsa u bol'nykh s progressiruiushchei stenokardiei.

The impact of laser blood irradiation (LBI) on electrical instability has been studied in 71 patients with progressive angina pectoris. The amount of couplets of ventricular premature beats after LBI was decreased, as evidenced by 24-hour monitoring. Invasive programmed ventricular stimulation provided better electrophysiological properties of the myocardium after LBI: primary examination showed that electrical ventricular instability was detected in 40%, but after the therapy it was only in 20% patients. Thus, LBI is an effective tool to decrease electrical ventricular instability, a major risk factor for sudden coronary death in patients with progressive angina pectoris.

[Changes in the parameters of the central and regional hemodynamics in patients with unstable stenocardia treated by the methods of quantum hemotherapy]. / Izmenenie parametrov tsentral'noi i regionarnoi gemodinamiki u bol'nykh s nestabil'noi stenokardiei pri lechenii metodami kvantovoi gemoterapii.

A study of 116 patients with nonstable stenocardia (age of the patients: 29-68 years). In 54 of them laser irradiation of the blood (LIB) was used, in 62--autorheography revealed a selective character of influence of LIB and ATIB on the hemo-hemotransfusion of irradiated blood (ACIB) and 32 received only drugs. Tetrapolar dynamics: tendency to averaging of the cardiac ejection. In patients with initially low values--an increase and with initially high values--a reduction. Possibly, this reaction has a nonspecific character and reflects the reaction of circulation to stabilization of the patients' condition. The hemodynamic parameters did not deteriorate below critical levels. Hence, these methods may be used in patients with nonstable stenocardia associated with initial disorders of the central and peripheral hemodynamics.